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India begins controlled trials of plasma therapy – Hindustan Times

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Trials using the antibody-rich blood of patients cured of the coronavirus disease (Covid-19) have begun, with doctors turning to a pool of 1,600 people in India who have recovered from the infection to test their antibodies as a potential cure for those fighting the disease.

Convalescent plasma therapy uses a blood component called plasma — which contains the virus-fighting antibodies – from people who have recovered from the infection to treat those who are severely ill with Covid-19.

Apart from the Indian Council of Medical Research – India’s apex health research body – at least two hospitals have applied to test the effectiveness of the therapy in Delhi, the protocols for which have been established .

The Institute of Liver and Biliary Sciences, an autonomous Delhi government hospital, has already received approval to conduct the trials. The private Max Hospital is awaiting approval to launch the trials.

“As the same product will be tested across the centres, the approvals are being given to hospitals that conform with the ICMR protocols so that uniform and comparable data is generated from across centres,” said an official from the Central Drugs Standard Control Organisation (CDSCO), the apex drug regulator.

When the virus enters the human body, the immune system creates an antibody to fight it. This antibody remains in a person even after the virus has cleared out of their system. In the absence of other drugs, experts say that using these antibodies from recovered patients can offer a reprieve to severely ill Covid-19 patients.

“Now, there are over 1,000 people who have recovered from Covid-19 in the country and their blood plasma can be used to treat those who are critical. The antibodies from the recovered person will theoretically help the critical patients in fighting the infection. This is done for other viral illnesses as well,” said Dr SK Sarin, director of the Institute of Liver and Biliary Sciences

The therapy would be given only to patients in a critical condition — those with a respiratory rate higher than 30 breaths per minute (the normal is 18-20 breaths per minute), have oxygen saturation of less than 90% (normal is 95 to 100%), or have infiltrates like pus in the lungs.

As for donors, only health individuals – with no comorbidities like diabetes, hypertension, or heart disease and less than 60 years of age – who have recovered from the infection would be selected.

“There are anecdotal evidences to say that Covid-19 patients on plasma therapy have recovered in other countries. However, we need to ensure that the therapy is given to people who are at high risk before they are on a ventilator. This is because the antibodies can prevent the progression of the disease by reducing the viral load, it cannot heal the lungs and the other organs. So, if a person already has lung damage and is in multi-organ failure then the therapy will not be useful,” said Dr Shobha Broor, former head of the department of microbiology at the All India Institute of Medical Sciences.

For the treatment, a plasmapheresis machine is used to derive plasma from the blood, which is then administered to the patients with severe infection. This method is, however, not new and is used for the treatment of several other diseases.

And experts feel that not giving the treatment to half the patients under randomised control trial is unethical. “Plasma therapy is already being used for three categories of ailments – one is viral infection such as hepatitis or even chicken pox that can be severe in immuno-compromised patients; two, it is done for autoimmune disorders, and three, conditions like haemophilia in which the people receive proteins other than antibodies – like factor 8 in this case – through plasma therapy,” said Dr T Jacob John, professor emeritus and former head of the department of virology at Christian Medical College, Vellore.

“When it is an already established procedure, why should it not be administered to all the patients who are very sick?. Not giving it to half the patients in need is actually an ethical problem, I feel,” he said.

In a randomised control trial, which is suggested by the ICMR, half the patients receive the plasma and the other half receive a placebo. This helps the doctors in determining whether people on therapy do better than those not on it.

A recently published report on a trial in China showed an improvement in the clinical conditions of 10 people who received the therapy. “All symptoms in the 10 patients, especially fever, cough, shortness of breath, and chest pain, disappeared or largely improved within 1 day to 3 day upon Convalescent Plasma transfusion,” the study published in PNAS Journal said.

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Whooping cough is at a decade-high level in US

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MILWAUKEE (AP) — Whooping cough is at its highest level in a decade for this time of year, U.S. health officials reported Thursday.

There have been 18,506 cases of whooping cough reported so far, the Centers for Disease Control and Prevention said. That’s the most at this point in the year since 2014, when cases topped 21,800.

The increase is not unexpected — whooping cough peaks every three to five years, health experts said. And the numbers indicate a return to levels before the coronavirus pandemic, when whooping cough and other contagious illnesses plummeted.

Still, the tally has some state health officials concerned, including those in Wisconsin, where there have been about 1,000 cases so far this year, compared to a total of 51 last year.

Nationwide, CDC has reported that kindergarten vaccination rates dipped last year and vaccine exemptions are at an all-time high. Thursday, it released state figures, showing that about 86% of kindergartners in Wisconsin got the whooping cough vaccine, compared to more than 92% nationally.

Whooping cough, also called pertussis, usually starts out like a cold, with a runny nose and other common symptoms, before turning into a prolonged cough. It is treated with antibiotics. Whooping cough used to be very common until a vaccine was introduced in the 1950s, which is now part of routine childhood vaccinations. It is in a shot along with tetanus and diphtheria vaccines. The combo shot is recommended for adults every 10 years.

“They used to call it the 100-day cough because it literally lasts for 100 days,” said Joyce Knestrick, a family nurse practitioner in Wheeling, West Virginia.

Whooping cough is usually seen mostly in infants and young children, who can develop serious complications. That’s why the vaccine is recommended during pregnancy, to pass along protection to the newborn, and for those who spend a lot of time with infants.

But public health workers say outbreaks this year are hitting older kids and teens. In Pennsylvania, most outbreaks have been in middle school, high school and college settings, an official said. Nearly all the cases in Douglas County, Nebraska, are schoolkids and teens, said Justin Frederick, deputy director of the health department.

That includes his own teenage daughter.

“It’s a horrible disease. She still wakes up — after being treated with her antibiotics — in a panic because she’s coughing so much she can’t breathe,” he said.

It’s important to get tested and treated with antibiotics early, said Dr. Kris Bryant, who specializes in pediatric infectious diseases at Norton Children’s in Louisville, Kentucky. People exposed to the bacteria can also take antibiotics to stop the spread.

“Pertussis is worth preventing,” Bryant said. “The good news is that we have safe and effective vaccines.”

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AP data journalist Kasturi Pananjady contributed to this report.

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The Associated Press Health and Science Department receives support from the Robert Wood Johnson Foundation. The AP is solely responsible for all content.

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Scientists show how sperm and egg come together like a key in a lock

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How a sperm and egg fuse together has long been a mystery.

New research by scientists in Austria provides tantalizing clues, showing fertilization works like a lock and key across the animal kingdom, from fish to people.

“We discovered this mechanism that’s really fundamental across all vertebrates as far as we can tell,” said co-author Andrea Pauli at the Research Institute of Molecular Pathology in Vienna.

The team found that three proteins on the sperm join to form a sort of key that unlocks the egg, allowing the sperm to attach. Their findings, drawn from studies in zebrafish, mice, and human cells, show how this process has persisted over millions of years of evolution. Results were published Thursday in the journal Cell.

Scientists had previously known about two proteins, one on the surface of the sperm and another on the egg’s membrane. Working with international collaborators, Pauli’s lab used Google DeepMind’s artificial intelligence tool AlphaFold — whose developers were awarded a Nobel Prize earlier this month — to help them identify a new protein that allows the first molecular connection between sperm and egg. They also demonstrated how it functions in living things.

It wasn’t previously known how the proteins “worked together as a team in order to allow sperm and egg to recognize each other,” Pauli said.

Scientists still don’t know how the sperm actually gets inside the egg after it attaches and hope to delve into that next.

Eventually, Pauli said, such work could help other scientists understand infertility better or develop new birth control methods.

The work provides targets for the development of male contraceptives in particular, said David Greenstein, a genetics and cell biology expert at the University of Minnesota who was not involved in the study.

The latest study “also underscores the importance of this year’s Nobel Prize in chemistry,” he said in an email.

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Older patients, non-English speakers more likely to be harmed in hospital: report

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Patients who are older, don’t speak English, and don’t have a high school education are more likely to experience harm during a hospital stay in Canada, according to new research.

The Canadian Institute for Health Information measured preventableharmful events from 2023 to 2024, such as bed sores and medication errors,experienced by patients who received acute care in hospital.

The research published Thursday shows patients who don’t speak English or French are 30 per cent more likely to experience harm. Patients without a high school education are 20 per cent more likely to endure harm compared to those with higher education levels.

The report also found that patients 85 and older are five times more likely to experience harm during a hospital stay compared to those under 20.

“The goal of this report is to get folks thinking about equity as being a key dimension of the patient safety effort within a hospital,” says Dana Riley, an author of the report and a program lead on CIHI’s population health team.

When a health-care provider and a patient don’t speak the same language, that can result in the administration of a wrong test or procedure, research shows. Similarly, Riley says a lower level of education is associated with a lower level of health literacy, which can result in increased vulnerability to communication errors.

“It’s fairly costly to the patient and it’s costly to the system,” says Riley, noting the average hospital stay for a patient who experiences harm is four times more expensive than the cost of a hospital stay without a harmful event – $42,558 compared to $9,072.

“I think there are a variety of different reasons why we might start to think about patient safety, think about equity, as key interconnected dimensions of health-care quality,” says Riley.

The analysis doesn’t include data on racialized patients because Riley says pan-Canadian data was not available for their research. Data from Quebec and some mental health patients was also excluded due to differences in data collection.

Efforts to reduce patient injuries at one Ontario hospital network appears to have resulted in less harm. Patient falls at Mackenzie Health causing injury are down 40 per cent, pressure injuries have decreased 51 per cent, and central line-associated bloodstream infections, such as IV therapy, have been reduced 34 per cent.

The hospital created a “zero harm” plan in 2019 to reduce errors after a hospital survey revealed low safety scores. They integrated principles used in aviation and nuclear industries, which prioritize safety in complex high-risk environments.

“The premise is first driven by a cultural shift where people feel comfortable actually calling out these events,” says Mackenzie Health President and Chief Executive Officer Altaf Stationwala.

They introduced harm reduction training and daily meetings to discuss risks in the hospital. Mackenzie partnered with virtual interpreters that speak 240 languages and understand medical jargon. Geriatric care nurses serve the nearly 70 per cent of patients over the age of 75, and staff are encouraged to communicate as frequently as possible, and in plain language, says Stationwala.

“What we do in health care is we take control away from patients and families, and what we know is we need to empower patients and families and that ultimately results in better health care.”

This report by The Canadian Press was first published Oct. 17, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

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